Physical exam for fibromyalgia

A physical exam for any suspected joint or muscle condition involves checking the:

  • Joints for range of motion, swelling, and warmth.
  • Skin for redness or rash.
  • Muscles for strength and general tenderness.
  • Nervous system for reflexes and ability to maintain balance.

These parts of the body are usually normal in a person who has fibromyalgia. An abnormal finding in one of these areas makes it more likely that you have a condition other than or in addition to fibromyalgia.

Tender points are 9 pairs of specific sites on the body (18 points in total) that cause pain when pressed. For a clear diagnosis of fibromyalgia, according to the American College of Rheumatology guidelines, a person must have pain at 11 or more of the 18 tender points.1

To evaluate tender points, the doctor may apply pressure on or near one of these points. In people with fibromyalgia, the points will often be tender and painful. The doctor will also press on areas that are not normally painful in fibromyalgia, such as the middle of the forehead or the nail beds.


  1. Bradley LA, Alarcon GS (2005). Fibromyalgia section of Miscellaneous rheumatic diseases. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions: A Textbook of Rheumatology, 15th ed., vol. 2, pp. 1869–1910. Philadelphia: Lippincott Williams and Wilkins.

Last Updated: October 21, 2009

Author: Shannon Erstad, MBA/MPH

Medical Review: Kathleen Romito, MD - Family Medicine & Richa Dhawan, MD - Rheumatology

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